| NPI | 1649236878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 333) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LC1125) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2009-10-09 |